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Healthcare in the Netherlands


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This presentation gives a brief insight in the current healthcare system in the Netherlands. This presentation was given in Praha

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Healthcare in the Netherlands

  1. 1. Healthcare in the Netherlands Focussed on hospitals Prague, 25 November 2009
  2. 2. Agenda Introduction Financing health care in the Netherlands Critical succesfactors for implementing a new system Lessons learned Trends and future developments Questions and discussion
  3. 3. Introduction - Current health care costs How to control health care expenditure in coming years? 13,3% 13,1% 13,1% % GDP in the Netherlands PM 6,3% 6,6% % GDP in The Czech Republic Total health care costs in the Netherlands * = preliminary figures 5,8% 4.809 4.545 4.315 Per person (in Euros) 6,2% 79.091 74.446 70.533 Total 0,4% 2.505 2.494 2.327 Administrative 5,7% 30.204 28.562 27.523 Cure 6,9% 46.382 43.390 40.683 Care ∆ 07/08 2008* 2007* 2006 in millions of Euros
  4. 4. Introduction – Healthcare model Cure Voluntary health care Care <ul><li>Coverage set by the insurance company </li></ul><ul><li>Additional health care is covered </li></ul><ul><li>Voluntary insurance </li></ul><ul><li>Care is fully covered </li></ul><ul><li>Tax based financed </li></ul><ul><li>All citizens covered </li></ul><ul><li>Coverage set by the government </li></ul><ul><li>Insurers have to accept everyone </li></ul><ul><li>Same premiums for all insured </li></ul><ul><li>Risk equalisation system applies </li></ul>Dentist, physiotherapy, plastic surgery and alternative care General practitioner, hospitals, ambulance and other lifesaving care Care for disabled people, care of the elderly, home care etc. (Insurance) coverage Kind of care included
  5. 5. Introduction – The objectives of the model <ul><ul><li>Competition (between healthcare providers) is expected to lower the costs and improve quality of health care </li></ul></ul><ul><ul><li>Standardise of the health insurance system for all citizens (to give a social guarantee for access to care) </li></ul></ul><ul><ul><li>Health insurance companies are expected better to direct the health care system than government is/was able to </li></ul></ul><ul><ul><li>Introduce market incentives </li></ul></ul><ul><ul><ul><li>improve cost awareness of citizens </li></ul></ul></ul><ul><ul><ul><li>improve quality of services (compete for customers) </li></ul></ul></ul><ul><ul><ul><li>improve quality of care </li></ul></ul></ul>The Dutch health care model combines social guarantees with market incentives
  6. 6. Financing health care in the Netherlands – in general – Health Care providers Health care insurers Risk Equalisation Government Policyholders Hospitals Etc. Employers Contribution Contribution Fees Premiums Personal contributions Tax Allowances Cure Settlements Government compensates for budget overruns
  7. 7. Financing health care in the Netherlands – hospitals Registration of primary activities and insight into cost prices of products are essential Financing guaranteed by the government Market prices negotiated with health insurance companies Budget based Based on market prices 2004 2020 2012 Parameters related to medical activities Parameters (30,000) based on fee for service model Parameters (3,000) based on fee for service model
  8. 8. Critical succesfactors for implementing a new system <ul><li>Hospitals </li></ul><ul><ul><li>A clear insight into the health care process and high quality registration of primary activities (medical surgery) </li></ul></ul><ul><ul><li>A clear insight into the cost structure of the hospital and cost price of products are essential in order to negotiate with insurance companies about sales prices and to manage the internal organisation </li></ul></ul><ul><ul><li>Governance structure must be clear, especially between board of directors and medical specialists </li></ul></ul><ul><ul><li>A solid financial position in order to cope with risks due to market forces (most hospitals in the Netherlands do not have enough equity to handle the risks) </li></ul></ul><ul><li>Government </li></ul><ul><ul><li>Set up adequate transitional arrangements to support hospitals to transfer to a market driven playing field </li></ul></ul><ul><ul><li>Accept that hospitals raise (temporary) their prices to build up their financial reserves </li></ul></ul><ul><ul><li>Accept that hospitals which are not adequately capitalized or not adequate managed face bankruptcy </li></ul></ul><ul><ul><li>Give licences to (new) parties who wants to enter the healthcare market. </li></ul></ul>Keep it simple
  9. 9. Lessons learned <ul><ul><li>Redesign of the health care industry maybe necessary but is not a magic formula for success </li></ul></ul><ul><ul><li>To create a sustainable health system objectives of health care providers, the insurance industry and government must be aligned </li></ul></ul><ul><ul><li>Compensation of budget overruns by the government frustrates cost efficiency </li></ul></ul><ul><ul><li>Accurate data and transparency is needed </li></ul></ul><ul><ul><li>Competition on price and quality is essential </li></ul></ul>
  10. 10. Trends and future developments <ul><ul><li>Reduction of the risk equalization model Insurance Act creates financial incentives for insurers to actively strive to achieve health procurement </li></ul></ul><ul><ul><li>Focus on quality indicators from insurers for monitoring the quality of care as part of the growing health procurement </li></ul></ul><ul><ul><li>Further specialization within hospitals in the years ahead </li></ul></ul><ul><ul><li>Control over macro-economic budget given aging of the Dutch population </li></ul></ul>
  11. 11. Trends and future developments – Measuring Quality – Distribution of hospitals in terms of ‘quality of care’. The blue mark indicates the percentage of hospitals performing less good than hospital X
  12. 12. University General practitioners Personal health care Elective non-complex care Specialized clinics Process oriented Market prices Basic hospital care Rural hospitals Compliants oriented Performance-related funding Elective very complex care University Medical Centers and large hospitals Process oriented Licensed care and prices Top preference care University Medical Centers Disease oriented Performance-related funding and an academic surcharge Complexity Plan eligibility Trends and future developments – Financing hospitals –
  13. 13. Trends and future developments – Number of hospitals needed – <ul><li>Expected future developments (already seen at the WKZ (children hospital)) </li></ul><ul><ul><li>Integrate care across facilities and regions, rather than duplication service in stand-alone units </li></ul></ul><ul><ul><li>Deliver services in the appropriate facility, not every facility </li></ul></ul><ul><ul><li>Excellent providers can manage care delivery across multiple geographies </li></ul></ul><ul><ul><li>Hospitals are expected to have an emergency room for overall care </li></ul></ul><ul><ul><li>Hospitals shall specialize in a kind of treatment (e.g. cancer, diabetes etc) </li></ul></ul>
  14. 14. Questions and discussion
  15. 15. Other information <ul><ul><li>Contact information of the presenters </li></ul></ul><ul><li>Rutger Dijsselhof </li></ul><ul><ul><li>Director KPMG P.O. Box 6153 9702 HD Groningen, The Netherlands Tel + 31 50 522 2111 Email </li></ul></ul><ul><li>Arvid de Bruin </li></ul><ul><ul><li>Senior Manager KPMG Financial Services P.O. Box 43004 3540 AA Utrecht, The Netherlands Tel + 31 30 658 2300 Email </li></ul></ul>